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Hello everyone this is the second video in this series on interpreting chest x-rays the topic is the systemic approach and normal chest x-ray anatomy the learning objectives of this video are to be familiar with the systematic approach to interpreting chest x-rays and to know the correlation between Anatomy and normal shadows on the x-ray before just presenting a systematic approach I first wanted to mention a couple of important principles about it a systematic approach is most important for the clinicians the least experience with reading chest x-rays since it reduces the chance that important findings will be missed all aspects of chest x-ray interpretation should be included the individual elements of the approach should be examined in a sequence that's either logical and/or easy to remember and there is no one best system they'll all should begin with an assessment of the film's technical quality so the system I teach trainees is informally referred to as the ABIDE system it's not the only one, but it's certainly the most common at least in the U.S. it's also not perfect, but it's easy to remember each of those six letters refers to a specific anatomic structure even before the need to assess the technical quality then a stands for Airways B for bones and soft tissue C for the cardiac silhouette and mediastinum d for diaphragm which also includes assessment of the gastric air bubble usually located under the left hemidiaphragm before effusions in other words assessment of the pleura which actually includes findings beyond just pleural effusions and f for fields that is the lung fields lastly, although it's not explicitly part of the mnemonic is an assessment of lines tubes devices and prior surgeries such as turn on AMIS and valve replacements aside from the fact that it's easy to remember another nice thing about this mnemonic is that the lungs are examined near and this is a good idea because normally the lungs are the area of the greatest interest and the most likely to be abnormal therefore once the clinician finds an abnormality there it's very easy for him or her to forget examining the rest of the film I've seen more than one rib fracture missed due to the distraction over acute lung pathology you may have noticed that the list of items here lines up really nicely with the remaining videos in this series which of course is not a coincidence, but before you can identify pathology of each of these anatomic structures you first need to know where they are on the x-ray and what they normally look like so let's go through the x-ray anatomy of A to F one at a time an is for the Airways there are three anatomic airway structures that are typically visible on a normal x-ray they are the trachea which is normally in the midline and the right and left main bronchus remember that the patient's right will be on the left side of the screen to help you visualize these structures let me superimpose a drawing of them the left main bronchus tends to...
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